<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<link rel="stylesheet" type="text/css" href="style/admin.css" />
<link rel="stylesheet" type="text/css" href="style/global.css" />
<title>客户资料修改</title>
</head>

<body>
<div class="msgBox">
<h2>客户资料修改</h2>
<div class="bc">
<form action="?c=patient&a=save" id='ajax-form' method='post'>
<input type="hidden" name="PID" value="<?php echo $patient['PATIENT_ID']?>" />
<table class="tableForm" width="350px" border="0">
	<tr>
		<th height="35" width="80">患者姓名：</th>
		<td><input type="text" name="TRUE_NAME" value="<?php echo $patient['TRUE_NAME']?>" style="width:200px" class="qi_text" /></td>
	</tr>
	<tr>
		<th height="35" width="80">性别：</th>
		<td><input type="radio" name="SEX"  value="男" <?php echo $patient['SEX'] == '男' ? 'checked' : ''?>/>男<input type="radio" name="SEX" value="女" <?php echo $patient['SEX'] == '女' ? 'checked' : ''?>/>女</td>
	</tr>
	<tr>
		<th height="35" width="80">联系电话：</th>
		<td><input type="text" name="PHONE" value="<?php echo $patient['PHONE']?>" style="width:200px" class="qi_text" /></td>
	</tr>
	<tr>
		<th height="35" width="80">身份证号：</th>
		<td><input type="text" name="CARD" value="<?php echo $patient['CARD']?>" style="width:200px" class="qi_text" /></td>
	</tr>
	<tr>
		<th height="35" width="80">社保卡：</th>
		<td><input type="text" name="SOCIAL_CARD" value="<?php echo $patient['SOCIAL_CARD']?>" style="width:200px" class="qi_text" /></td>
	</tr>
	<tr>
		<th height="35" width="80">联系人：</th>
		<td><input type="text" name="LXR_NAME" value="<?php echo $patient['LXR_NAME']?>" style="width:200px" class="qi_text" /></td>
	</tr>
	<tr>
		<th height="35" width="80">联系人关系：</th>
		<td>
			<input type="text" name="RELATION" value="<?php echo $patient['RELATION']?>" style="width:200px" class="qi_text" />
		</td>
	</tr>
	<tr>
		<th style="vertical-align: top;">联系人电话：</th>
		<td><input type="text" name="LXR_PHONE" value="<?php echo $patient['LXR_PHONE']?>" style="width:200px" class="qi_text" /></td>
	</tr>
	<tr>
		<th height="35">&nbsp;</th>
		<td>
			<input id="save-patient-btn" class="btn_gray" name="sub_ask" type="submit" value="提 交" />
			<button id="close-patient-btn" class="btn_gray" name="close" >取 消</button>
			<span class='red' id='msg'></span>
		</td>
	</tr>
</table></form>
</div>
</div>
<script type="text/javascript" src="js/jquery.js"></script>
<script type="text/javascript" src="js/comm.js"></script>
<script type="text/javascript">
$(function() { 
    $('#save-patient-btn').click(function(e) {
        JYCsm.form.ajaxPost({formSelector:'#ajax-form', dlgId:'patient-form-dlg'});
        return false;
    });
    $('#close-patient-btn').click(function(e) {
        JYCsm.closeWindow('patient-form-dlg');
        return false;
    });
});
</script>
</body>
</html>